Lessons from our Pupils: A Reflection [Podcast Episode 149]

In Episode 149 (LINK), Jay was joined by Dr. Jean-Pierre Hubschman to discuss robotic surgery and its future in the field of Ophthalmology. For this post, we thought it would be interesting to look back at how robotic surgery developed and where it stands today.

The introduction of robotics in industry began in 1951 with the first mechanical arm constructed to handle radioactive material. Ten years later, the first industrial robot was constructed for General Motors. In medicine, it was not until 1983 that a robot would be utilized to assist in a surgery. The Arhtrobot, designed in Vancouver, was used in orthopedic surgical procedures and performed over 60 arthroscopic procedures. Two years later, the PUMA 200 was used to perform a CT-guided brain biopsy (Figure 1). This was so successful, that it started being used for urological procedures at the Imperial College in London, in 1988. Two different models were used for prostate surgery that had the same limitations: the robots could be programmed based on a fixed anatomical landmark but could not be used for dynamic surgical targets.   

Figure 1: PUMA 200

Image credit: http://gelookahead.economist.com/slideshow/the-future-of-surgery/

During the 1990’s the Automated Endoscopic System for Optimal Positioning (AESOP) was built. This endoscopic camera could be controlled by the surgeon’s voice commands and was utilized for a variety of surgeries including laparoscopic cholecystectomy, hernioplasty, fundoplication, and colectomy. This robotic model was taken a step further with Zeus, a system created with arms and surgical instruments that could be controlled by the surgeon (Figure 2). Zeus was used for the first time in 1998 at the Cleveland Clinic for a fallopian tube anastomosis. In 2001 this model was used for the first transatlantic surgery, a laparoscopy performed in Strasbourg while the surgeon, Dr. Jacques Marescaux, was in New York.

Figure 2: Zeus robotic surgical system. a. surgeon console, b. robotic arms.

Image credit https://link.springer.com/article/10.1007%2Fs00268-016-3543-9

Around the same time the da Vinci system was designed. First used in 1997 for a robotic-assisted cholecystectomy in Brussels, Belgium this model gained popularity and in 2000 the FDA approved it for abdominal surgeries. This model overcame many of the previous robots’ limitations. It could now replicate exactly what a human arm could do. The system consists of three parts: a Vision System that includes a high-definition 3D endoscope and large viewing monitor, a Patientside Cart with the robotic arms controlled by the surgeon, and the Surgeon Console from where he or she performs the surgery. Throughout the years this system has been upgraded. Most notably, in 2002 the robot consisted of three operating arms. In 2006 the new model gave better handling and increased range of motion, allowing for a bigger surgical field. Finally, in 2009 the imaging system was upgraded, and a second surgeon’s console was added to allow less experienced surgeons to train. While robotic surgery is now commonly being used in many different fields of medicine—including neurosurgery, GI, urology, orthopedic surgery and more—it is still in its infancy in ophthalmology. As technology progresses, robotics are expected to be introduced more into ophthalmic practice. As discussed in this episode, the two areas that are expected to first see the use of robotics will be vitreoretinal and cataract surgeries.

Figure 3: da Vinci Surgical System.

Image credit: https://www.davincisurgery.com/da-vinci-surgery/da-vinci-surgical-system/